A recent study (T Oshima et al. Aliment Pharmacol Ther 2019; 49: 140-6) showed that a new potassium-competitive acid blocker (P-CAB) can more rapidly improve symptoms than lansoprazole. Thanks to Ben Gold for this reference.
This small study with 32 adult patients with endoscopically-confirmed erosive esophagitis with frequent heartburn were randomized in a double-blind study and received either lansoprazole 30 mg or vonoprazan 20 mg before breakfast. The authors note that with PPIs, there is a slow onset of action, such that ‘half of all patients remain symptomatic even after 3 days of treatment.” In contrast, vonoprazan can increase intragastric pH to almost 7 within 4 hours.
- Heartburn relief occurred quicker with vonoprazan. Complete relief was noted in 31.3% at day 1 compared with only 12.5% in the lansoprazole group.
My take: Vonoprazan is currently approved in Japan.
Related article: Update on the Use of Vonoprazan DY Graham, MP Dore; Gastroenterol 2018; Volume 154, Issue 3, Pages 462–466